title: Economic burden of renal cell carcinoma in the US: Part II--an updated analysis.
abstract: BACKGROUND
  The economic burden of renal cell carcinoma (RCC) came into sharp focus when the UK's National Institute for Health and Clinical Excellence denied coverage (later reversed) of sunitinib for metastatic RCC. Following an updated review of RCC-related economic studies, we supplemented the costs of RCC reported in the literature with estimates from the latest US databases that capture the utilization of several newly approved targeted agents.
  
  
  METHODS
  We conducted analyses using the 1991-2007 SEER (Surveillance, Epidemiology and End Results)-Medicare and 1996-2007 MarketScan Commercial Claims and Encounter (CCAE) and Medicare Supplemental databases, and based our estimates on a prevalent cohort of patients with RCC or kidney cancer constructed from each database. All cost estimates were normalized to $US, year 2009 values. The incremental costing approach was applied to estimate the annual cost of RCC by treatment phases using a prevalent cohort of patients with RCC identified from the 2005 SEER-Medicare database. We used the method of extended estimation equations to estimate the impact of patients' use of targeted therapies on the annual costs of RCC, while controlling for confounding factors such as patients' age, sex, tumour characteristics, co-morbidity and geographic regions. The method was applied to two elderly cohorts of RCC patients identified from the SEER-Medicare and the MarketScan Medicare Supplemental databases and a non-elderly cohort of patients with RCC identified from the MarketScan CCAE database.
  
  
  RESULTS
  Compared with the cost of treating an elderly, non-cancer patient in the matched sample, the average cost of treating an elderly patient with RCC was $US11,169 (95% CI 10,683, 11,655) more per year, based on our analyses of the latest SEER-Medicare data. The annual cost to treat patients with RCC who received targeted therapies was 3- to 4-fold greater than the cost to treat patients with RCC who received other therapies. Results from the multivariate analysis showed that, after controlling for potential confounders, the annual medical cost was $US31,000-65,000 higher for RCC patients treated with targeted therapies, with the largest increase observed among the non-elderly patients.
  
  
  CONCLUSIONS
  The economic burden of RCC is likely to grow with an increasing use of targeted therapies. Future research is needed to understand the impact of various forces on the economic burden of RCC, such as increased disease incidence, use of minimally invasive surgical techniques and more prevalent adoption of emerging targeted therapies.
authors.affiliation: Section of Health Services Research, Department of Biostatistics, Division of Quantitative Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. tinashih@uchicago.edu
authors.forename: Ya-Chen T
authors.initials: YC
authors.lastname: Shih
authors.forename: Chun-Ru
authors.initials: CR
authors.lastname: Chien
authors.forename: Ying
authors.initials: Y
authors.lastname: Xu
authors.forename: I-Wen
authors.initials: IW
authors.lastname: Pan
authors.forename: Grace L
authors.initials: GL
authors.lastname: Smith
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Buchholz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000188:drug therapy / Q000191:economics* / Q000628:therapy; D016208:Databases, Factual; D005249:Fees and Charges; D005260:Female; D005102:Health Expenditures; D006801:Humans; D008297:Male; D006278:Medicare; D014481:United States